Background and Aims Posterior C spine fusion surgeries will lead to severe post-operative pain arising from tissue trauma which affects the physiological functions of circulation and respiration as well as seriously affects early activities. We share our experience in this 4 cases which were managed with erector spinae along with GA which was effective during perioperative period.
Methods After informed written consent all 4 patients were anaesthetised by using standard general anaesthesia protocol and positioned prone. High frequency US probe (FUJIFILM SONOSITE M TURBO) placed over the transverse process of C7 (case 1), T1 (case 2), T2 (case 3 & 4) to identify the erector spinae muscles (ESM). Using 23 G quincke needle, by in plane approach the needle tip was placed between ESM and the transverse process. After confirmation with saline, B/L CESPB was given (15 ml of 0.25% bupivacaine + 4 mg dexamethasone) on each side. Inj. paracetamol 15 mg/kg was given before skin incision and continued 6th hourly for 1st24 hrs post op. All patients hemodynamics were monitored. Postoperative pain was assessed using VAS score every hour for the 1st12 hours and 2nd Hourly till 24 hours. Inj tramadol 50 mg was used for breakthrough pain (VAS score ≥ 4 ) in the post op.
Results No additional opioids were requried during intra op peroid
Reduced post op opioid requirements
Promotes early mobilization
Conclusions We found CESPB provides an excellent site specific intra op and post-op analgesia and reduces the perioperative opioid requirements; thereby promotes early mobilization and hospital discharge.
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